Healthcare Provider Details

I. General information

NPI: 1780082768
Provider Name (Legal Business Name): ASHLEY JO GARCIA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ASHLEY JO SONI NP

II. Dates (important events)

Enumeration Date: 12/08/2014
Last Update Date: 12/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2995 BASELINE RD STE 210
BOULDER CO
80303-2318
US

IV. Provider business mailing address

5450 WESTERN AVE
BOULDER CO
80301-2709
US

V. Phone/Fax

Practice location:
  • Phone: 303-443-2544
  • Fax: 303-443-6476
Mailing address:
  • Phone: 303-415-8900
  • Fax: 303-443-6476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.0168183
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0991456-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: